Provider Demographics
NPI:1316518806
Name:JEANMARIE, ANTOINE ROGER (MA, MBA)
Entity type:Individual
Prefix:MR
First Name:ANTOINE
Middle Name:ROGER
Last Name:JEANMARIE
Suffix:
Gender:M
Credentials:MA, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 129TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-6940
Mailing Address - Country:US
Mailing Address - Phone:954-224-4672
Mailing Address - Fax:
Practice Address - Street 1:2415 129TH AVE E
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-6940
Practice Address - Country:US
Practice Address - Phone:954-224-4672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1842915Medicaid